Dissociative [conversion] disorders - F44 Flashcards
What are dissociative disorders?
Was once called ‘conversion hysteria’
Partial/complete loss of normal integration between memories of the past, awareness of identity and immediate sensation and loss of bodily movements
Tend to remit after weeks-months, especially if associated with traumatic event; If associated with chronic interpersonal difficulties or other problems – long standing paralyses anaesthesias may develop
What types of symptoms present?
Symptoms often represent the patient’s concept of how a physical illness would manifest
Physical examination doesn’t reveal physical illness
LoF is thought to represent an expression of emotional conflicts/needs
Suddenly develops in close relationship to psychological stress
Symptoms included here are only concerned with functions that are usually under conscious control
What disorders come under dissociative disorders?
Dissociative: Amnesia Fugue Stupor Convulsions Anaesthesia and sensory loss And Trance and possession disorders
What is dissociative amnesia?
Loss of memory, of important recent events, usually partial and selective
Centred around traumatic event
Not due to organic disorder or forgetfulness or fatigue
What is dissociative fugue?
Dissociative amnesia + purposeful travel beyond usual everyday range (= a fugue)
What is dissociative stupor?
Profound diminution/absence of voluntary movement and normal responsiveness to external stimuli
What are dissociative convulsions?
Mimic epileptic seizures closely but tongue biting, bruising from falling, incontinence are rare; consciousness maintained, replaced by trance/stupor
What is dissociative anaesthesia and sensory loss?
Areas of skin often have clear boundaries relating to their bodily function rather than medical knowledge
May be differential loss between sensory modalities which cannot be possible from a neurological lesion
Possible complaints of paraesthesia; loss of vision and hearing are rarely total in dissociative disorders
What are trance and possession disorders?
Temporary loss of sense of personal identity and full awareness of surroundings
Only those trances that are unwanted/outside of religious and culturally accepted situations
How do you treat dissociative disorders?
Watch and wait - lots of feelings of dissociation will pass with time
CBT, DBT and EMDR may help with long standing cases
Antidepressants can help alleviate some symptoms and deal with co-morbid issues
What is dissociative identity disorder (DID)?
The presence of two or more identities with distinct patterns of perception and personality which recurrently take sudden control of the person’s behaviour + a retrospective gap in memory of important personal information that exceeds ordinary forgetfulness
Changes in identity not due to substance use or general medical condition
What causes DID?
Aetiological controversy:
some proponents argue that it occurs due to significant childhood trauma, as a way for the individual to cope; others argue it is therapist induced - as there are few diagnosable cases in children, the symptoms seem to manifest themselves fully after the exploration of the trauma; patients with DID have been shown to be highly susceptible to suggestion (easily persuaded in the hypnotic like states of therapy); only a small number of therapists responsible for diagnosis etc
What is DID associated with?
Multiple other conditions such notably borderline personality disorder as well as mood disorders, substance misuse and PTSD
How do you treat DID?
Patient functioning ie around emotional processing, reactions to stress and collateral disorders can be improved with trauma focused psychotherapies but integration into a consistent whole is rare
What is Ganser syndrome?
Ex factitious disorder, now dissociative
Nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness
Rare but most common in prisons, may be seen to be used to gain benefits
